The Internet as anti-vaccine tool

The United States seems to be on track to have more measles cases than any year in more than a decade, with virtually all cases linked to other countries, including Europe where there’s a big outbreak.

Already there have been 89 cases reported so far. The U.S. normally sees only about 50 cases of measles in a year thanks to vaccinations.

Health officials are reluctant to make predictions, but acknowledge the pace of reports is unusually hot.

“It’s hard to say, but we’re certainly getting a lot,” said Dr. Greg Wallace, who leads the measles, mumps, rubella and polio team at the U.S. Centers for Disease Control and Prevention.

Europe, especially France, has been hit hard by measles, with more than 6,500 cases reported in 33 nations. International health officials are blaming it on the failure to vaccinate all children.

Just about all U.S. outbreaks were sparked by people bringing it here from other countries. This week, international health officials posted an alert urging travelers everywhere to get the recommended two doses of vaccine before flying overseas.

For the most part, U.S. measles vaccination rates remain reassuringly high. However, even though overall vaccination rates remain high, there appear to be increasing numbers of pockets of vaccine resistance where the percentage of vaccine uptake has fallen below that necessary for herd immunity, particularly in affluent coastal cities. When that happens, if measles finds its way into a community with low vaccine uptake rates, the chance of an outbreak, even a major outbreak, rises. Given that international travel is common and relatively easy, this means that low vaccine uptake rates overseas can represent a hazard to us here in the U.S., as travelers can bring the virus into populations whose herd immunity might not be adequate to prevent its spread. It also has to be remembered that the MMR vaccine, while very effective, is not 100% effective. As the article cited above notes, it’s quite possible to be fully vaccinated and become ill; the difference is that the odds of contracting measles are much lower if you’re vaccinated. That’s why the common anti-vaccine refrain that says that you shouldn’t worry about unvaccinated children being a threat to your children if you’ve vaccinated them is nonsense. True, they’re not as big a threat, but they’re still a threat.

The anti-vaccine movement, at least the Wakefieldian wing that says that the MMR vaccine causes autism, is definitely stronger in the U.K. than it is here and arguably also stronger in Europe than it it is here. It is therefore not surprising that we are seeing cases of measles in the U.S. as a result of European travelers bringing it here, although that is by no means the only source; travelers from Third World countries, where vaccine uptake rates can be quite low, are another major source. If we are not careful, MMR uptake rates could fall here as well, perhaps making American travelers vectors of infection delivering measles virus to other countries. Given how incredibly infectious and easily transmissible the measles virus is, it doesn’t take a lot. Be that as it may, it was interesting to me that less than a day before seeing the report above, I had run into this analysis on Eurosurveillance of the role of health information on the Internet in influencing decisions to vaccinate or not to vaccinate. After providing background about how vaccines have become a victim of their own success, such that people now focus far more on their potential side effects than the dangers of the diseases prevented by them, how distrust of vaccines fueled by the anti-vaccine movement has led to decreases in vaccine uptake rates, particularly in the U.K., and how the WHO failed to reach its goal of eradicating measles by 2010 and had to push that target back to 2015, the report sets the stage:

This paper takes a first step in exploring the role of the Internet in influencing anti-vaccination decisions from a psychological perspective and examines how vaccination risk perception and decision process are affected by information on the Internet. The main points were also presented at the 2010 Eurovaccine conference [6]. From a psychological point of view it is assumed that during the pre-decisional phase of the decision process, the problem at hand (to vaccinate or not) is identified and the person making the decision acquires the necessary information, e.g. via an Internet search (see Figure 1) [7]. In the selectional phase, potential outcomes of the alternatives are evaluated (appraisal, e.g. the risk of suffering from side effects after vaccination). Finally the decision is made. In the post-decisional phase the decision needs to be implemented and the person making the decision receives feedback (e.g. about the actual occurrence of side effects). All information is stored in the memory and will influence future decision processes. This paper focuses mainly on information search, its influence on risk perceptions, vaccination intention and finally behaviour.

So this study is looking solely at the pre-decision phase of vaccination; i.e., the information-gathering phase. As part of that analysis, the author first summarized data regarding the Internet as a source of health information in general and anti-vaccine information in particular, with some disturbing observations, making a rather disturbing observation. As a test case, a search was made for “hand cleaning” during the H1N1 pandemic of 2009-1010, which lead to WHO recommendations about handwashing and other infection prevention recommendations 75-80% of the time. In other words, for this term, the chance of someone searching about information on hand washing finding reliable health information was quite high, although I must admit that I was surprised that the percentage was only 80% at best. In contrast, searching for terms related to vaccines tend to have a higher chance of pulling up anti-vaccine websites, with the further observation that, the more general the term used, the more likely that anti-vaccine websites will appear higher on Google search results. This is relevant because of recent work cited that suggests that the parents’ knowledge about vaccination influence the complexity of the search terms they use. Parents who are better-informed will use more specific and complex search terms and be less likely to find anti-vaccine websites. In contrast, less knowledgeable parents are more likely to conduct searches and use less complex terms in doing so, leading to more anti-vaccine websites, which they are less able to evaluate critically because of their lack of knowledge. It’s a vicious circle.

The bottom line is that, as much as we make fun of them (and rightfully so, at least from a scientific perspective), anti-vaccine websites are effective through recycling several common arguments:

In terms of page content, all eight vaccine-critical Internet sites analysed by [3] were concerned with vaccine safety and claim a causal relationship between vaccinations and illnesses of unknown origin, e.g. multiple sclerosis, autism, asthma and sudden infant death syndrome. Arguments are continually repeated, for example: vaccines erode immunity (seven of eight), create only temporary or ineffective immunity (seven of eight), contain many ingredients and preservatives that will make you sick (eight of eight), overwhelm children’s immune systems, especially when administered in combination (three of eight). At the same time, treatments superior to vaccination are promoted, e.g. homeopathy (seven of eight). In addition, anti-vaccination websites are very well connected, as they all provide links to similar sites [3].

It’s true, too. One of the reasons anti-vaccine websites tend to percolate up so high on Google search results is because they are so highly inter-linked. They often have savvy web designers who know how to optimize their pages and blogs to appear as high as possible on Google search results for vaccine-related terms. In contrast, we who defend science-based medicine against the pseudoscience of the anti-vaccine movement are often far behind the curve.

But why are anti-vaccine websites so effective? The Eurosurveillance analysis confirms something I’ve been writing about from the very beginning of this blog, namely the power of testimonials. Testimonials aren’t just for cancer; they work for lots of anti-science and quackery, and their power is widely harnessed to serve the anti-vaccine movement by appealing to the emotions of parents, which when it comes to their children are particularly powerful:

A key feature on seven of the eight examined websites was the inclusion of emotive appeals, such as pictures and stories of children who were supposedly harmed by vaccinations. An example for such descriptions of personal experiences, posted on a German website, reads as follows: ‘My four year-old daughter received the five-in-one combination vaccine at nine months, she then had a fever for two weeks, was apathetic and had screaming fits, since then she has suffered from atopic dermatitis and many allergies. My son is now four months old and I don’t know if I should get him vaccinated or not (…)’. Parents appear to have a preference for personal information when searching on health related topics, i.e. information from parent to parent: even parents-to-be already search for such information, mainly through internet forums (bulletin boards) where they can post questions that are then answered by other parents [15].

The author summarizes that approximately 1 in 5 hits in Google searches on vaccines will lead to anti-vaccine websites and blogs (which, quite frankly, strikes me as a bit low, but the study was done before the rise of Twitter and Facebook), the vast majority of which prefer frightening testimonials of “vaccine injury” over scientific evidence. Indeed, one of my favorite examples of this the NVIC International Memorial for Vaccine Victims, which is nothing more than a bunch of unsubstantiated testimonials in which the adverse reaction reported may or may not be related to vaccines. Jenny McCarthy’s anti-vaccine group Generation Rescue takes it one step further, with a webpage featuring “vaccine-injured” children who were “recovered” using biomedical quackery. Because, as I’ve discussed many times before, correlation does not necessarily equal causation and autism is a condition of developmental delay with waxing and waning symptoms, these stories seem very compelling on the surface. These testimonials can be highly effective in producing an exaggerated perception of risk due to vaccines and an incorrectly low estimate of vaccine effectiveness in preventing disease. It is, as I have at times characterized it, misinformed consent, because the parent is refusing vaccination based on misinformation.

The effectiveness of misinformed consent is illustrated in this graph from the report:

As you can see, anti-vaccine websites increase parents’ estimation of the risk of vaccinated and decrease their estimation of the risk of not vaccinating, the latter of which is frequently downplayed heavily in anti-vaccine websites.

So how to combat this emotive misinformation? Based on this report, it’s hard to say. The author discusses the use of emotive pro-vaccine appeals that play on the fear of disease, for instance by showing pictures of children who suffered encephalopathy after measles? However, most scientists are very uncomfortable about this approach, and the author correctly asks, “Should fear be fought with fear?” She also cites a study finding that stronger statements of risk negation can paradoxically lead to a higher perception of risk than weaker statements of risk negation, as well indicating that the source matters a lot. Indeed, strong statements of risk negation by a source parents find untrustworthy actually appear to increase the perception of risk. Of course, different parents will find different sources more or less trustworthy. For instance, anti-vaccine parents do not trust Paul Offit; his pronouncements are actually probably more likely to harden their positions. However, parents who are on the fence probably do not view him as negatively and might even view him positively, making him more effective with this population.

The resurgence of measles stresses the particular urgency to answering the question of how to communicate science and relative risk accurately to the public in a way they can understand. Failure could well result in the return of, if not the bad old days before vaccines could prevent so many deadly diseases, days that are quite bad enough.

124 Comments

DAMN! DAMN! DAMN! I don’t want to be get measles at age of 40-something. I am NOT immune, the vaccine doesn’t work for me (or at least, has not in the past) and I’ve FREAKING HAD THE MEASLES!!! I don’t want them again. I want to crawl into a plastic bubble until people get their heads out of their collective rears and realize that there are many of us of all ages at risk due to their stupid beliefs about fradulent data. Damn Andy Wakefield. Damn AOA and DAMN the uneducated people who believe vaccines cause autism crap.

(little augie warning: don’t post your usual trolling remarks or I will be tempted to “out” you to the most fun people I know on the internet. If you post anything, make it evidence based, without straw men, ad hominens or lies.)

I live near one of those affluent coastal cities…I have a baby girl, who is fully vaccinated. It really annoys me that I have to ask other parents if they vaccinate before visiting or for playgroups. One local playgroup is almost entirely unvaccinated. We went once before I found out. I am not willing to risk exposure on the chance that one of the vaccines isn’t fully protecting her.

Many of my neighbors are immigrants, and they always vaccinate their children. I asked about it once – some of the diseases are still prevalent in their home countries so they are pro-vaccine.

The amount of bad and conflicting information out there is horrible. I have been having really bad acid reflux the past 2 months, and trying to determine what is safe to eat. Most sites I find are really just scrapes of other sites with ads put on. Most sites (esp alt med) have really horrible advice.

For instance: they will blindly list stuff that makes your stomach feel better, but acid reflux is not an ulcer or gastritis (and i had gastritis on top of the reflux) some things that help gastritis actually worsen acid reflux esp. if they relax smooth muscle tissue. But you won’t find that nuanced advice. But to an acid reflux sufferer it is definitely important!

I got my tdap last year. I have been trying to convince my girlfriend to get one I think i will try harder. I wonder if measles needs a booster.

Generally, that is true, but according to numerous titers I have had in my life, I am not immune and the vaccines don’t give me immunity. And my mother knew well what measles looked like so she is certain that I had them. (Documented in my baby book as well as my immunization record from my doctor).

Yes, and lies should be met with ridicule. Seriously, there’s a difference between scientifically-grounded fears of death and complications of vaccine-preventable childhood disease and the lies of chicken little. It’s perfectly legit to combat chicken little by pointing at the fox waiting in the cave (the return of vaccine preventable diseases, expensive and ineffective and/or directly harmful CAM.)

{anecdote}
“Boy, am I glad I had my child vaccinated when I did. Her school had several non-vaccinated children in it who caught Pertussis, and if it hadn’t been for the vaccine, it could have been her! I’ve heard all the people say that vaccines cause autism, but there’s really nothing to it. And I -know- vaccines saved my daughter from getting sick!”
{/anecdote}

No better than what the anti-vaxxers have, but it should be at least as effective, no?

That’s why the common anti-vaccine refrain that says that you shouldn’t worry about unvaccinated children being a threat to your children if you’ve vaccinated them is nonsense. True, they’re not as big a threat, but they’re still a threat.

@Laura: it is generally an idiosyncratic thing. In my case, it’s very weird, because I have developed normal titers for all other illnesses (vaccine-preventable) that I either had or had the vaccine for. Don’t know why I don’t get immunity to measles. Don’t know why having the measles didn’t give me immunity. But I don’t want to get them again. (I’ve had the single measles injection, WAY back in the 1960s, after I had the measles, I had the MMR in the 1970s, and another MMR when I went to graduate school in the 1990s since my titers showed non-immunity. If measles hits my state, I will probably ask my doctor for another one, just to see if the 5th time is the charm…)

I can’t access Rene’s post to give you the URL. Todd? Repeat please?

PS Ignore Thing. Thing is a troll who believed children are never exposed to illness if they have good parents. Thing also believes other hilarious things and can be good for laughing and pointing when you are in a bad mood.

I read some things online saying that in the 1960’s, a lot of people in the US were vaccinated with a measles vaccine that wasn’t effective. This may be part of why measles is getting more common. See http://www.npr.org/templates/story/story.php?storyId=5497945
So if you don’t have enough measles antibodies, that doesn’t necessarily mean that measles vaccines don’t work for you.
I would have been vaccinated in the 60’s …

Orac should advise its minions to take remedial classes in Immmunology 101 than parading their ignorance in this board.

No, you should.

The immune system is random. Sometimes B cells make an antibody that recognizes, but does not neutralize the virus. If these dominate the immune response, then there won’t be any humoral immunity from the immune insult. Upon reexposure, the same B cells are activated again and you get the same nonproductive immune response.

Indeed, one of my favorite examples of this the NVIC International Memorial for Vaccine Victims, which is nothing more than a bunch of unsubstantiated testimonials in which the adverse reaction reported may or may not be related to vaccines.

Someone tried to tell how bad vaccines were by sending me to that site. When I checked it the testimonial was about vaccines causing Down Syndrome, also known as Trisomy 21 because of the specific chromosome!

The immune system is random. Sometimes B cells make an antibody that recognizes, but does not neutralize the virus. If these dominate the immune response, then there won’t be any humoral immunity from the immune insult. Upon reexposure, the same B cells are activated again and you get the same nonproductive immune response.

It’s so obvious you just created that stuff. I am pretty sure you are not confident with your answer as well.

Chris, in ThWorld anything that eventually winds up in the blood stream is intravenous. I just had an intravenous dose of vanilla coke (one of my weaknesses) and tonight I’ll have an intravenous dose of delicious barley soup.

Which part of the that link where it says intravenous Bordetella pertussis vaccine don’t you understand?

So you’re saying the pertussis vaccine cannot be given intravenously? Just give the ol’ nurse lilady a pertussis vaccine and she’ll give it you intravenously. You know that nurse can give PPD test beneath the skin and able to get away with negligence repeatedly. Oh yeah you can also have the triad DTaP IV as well!

It’s so obvious you just created that stuff. I am pretty sure you are not confident with your answer as well.

If it’s so obvious, why haven’t you provided any evidence showing otherwise?

Which part of the that link where it says intravenous Bordetella pertussis vaccine don’t you understand?

Chris understood it perfectly. What you failed to notice was that the vaccines were given to mice.

So you’re saying the pertussis vaccine cannot be given intravenously? Just give the ol’ nurse lilady a pertussis vaccine and she’ll give it you intravenously. You know that nurse can give PPD test beneath the skin and able to get away with negligence repeatedly. Oh yeah you can also have the triad DTaP IV as well!

Find me a textbook which states veins and capillaries are identical, then I might believe you. Not going to happen, however.

You see, there’s a big difference between driving safely and vaccine-induced infections. Infection-promoters like you should definitely focus on the latter because even with simple analogy, you guys fail miserably. So when do you plan to drive recklessly?

Considering your strategy is “don’t expose yourself to disease” (because all infected people turn blue or something) I’m sure your strategy for avoiding car crashes is “don’t get in to an accident.”

If you can read vaccine labels and understand science, then you must also avoid vaccines. Apparently, you’re incapable of such.

BTW, vaccination is never an accident. It is routine. It has a schedule and it is recommended. Its intent is to infect whether you like it or not. So stop analogizing and stick with science. Unfortunately, for vaccine apologists, analogies far outweigh the science.

At the same time, treatments superior to vaccination are promoted, e.g. homeopathy

Now that is what I call badly phrased.

The interesting thing about figure 2 is that it seems as though the dominant factor in influencing intent to vaccinate is not perception of the risk of vaccination, but rather perception of the risk of not vaccinating. So perhaps the message here is to concentrate on informing people of the dangers of vaccine-preventable diseases.

PS Ignore Thing. Thing is a troll who believed children are never exposed to illness if they have good parents. Thing also believes other hilarious things and can be good for laughing and pointing when you are in a bad mood.

Triskele, I hope you’re right. What concerns me is the possibility, suggested by the abbreviation “Th1Th2” that we may be dealing with both Thing One and Thing Two. If I recall correctly, those two fairly destroyed Sally’s house while trying to fly kites indoors after the Cat[1] in the Hat, in a disastrously ill-advised move, let them in. Now, granted, here we appear to be dealing with a string of non-sequiturs framed as weirdly distorted but almost recognizable references to terms plucked at random from an immunology text, which is not quite as bad as flying kites in the house. But it cannot end well.

[1]Bipedal, which is the international sign of a mischievous cat. Cats with more than two legs are fine by me.

This shows exactly how little you actually know about immunology. It’s a well known phenomenon, particularly with regards to HIV. Non-neutralizing antibodies have been shown to have some role especially in non-lytic viruses like HIV.

Oh really? We should stop vaccinating then since its worthless a.k.a. not 100% effective.

@triskelethecat I had the same problem with the hepatitis B vaccine – despite numerous doses my antibody titers never reached the recommended level. I just take a great deal of care when working with blood, which is wise given the prevalence of HIV anyway, though it’s nowhere near as infectious as hep B.

The immune system is random. Sometimes B cells make an antibody that recognizes, but does not neutralize the virus. If these dominate the immune response, then there won’t be any humoral immunity from the immune insult. Upon reexposure, the same B cells are activated again and you get the same nonproductive immune response.

It’s so obvious you just created that stuff. I am pretty sure you are not confident with your answer as well.”

Granted, the immune system is not necessarily “random” per se, but your reply to your quoted text is just stupid. Clearly you have no understanding of immunology because you would have refuted your quoted text with actual facts on how these mechanisms are known to work. Perhaps B cells were selected and clonally expanded, but had low affinity for antigen. Perhaps there was a problem with the constant region of produced antibodies that didn’t allow for opsonization. Perhaps there was a premature isotype switch that inhibited the action of said antibodies. Learn about clonal selection and expansion, and immunological memory. Then get back to us.

I have developed normal titers for all other illnesses (vaccine-preventable) that I either had or had the vaccine for. Don’t know why I don’t get immunity to measles. Don’t know why having the measles didn’t give me immunity.

I read that the measles vaccine is particularly likely to fail. It doesn’t necessarily work for babies; the killed vaccine used in the 60’s wasn’t very effective; the live vaccine used later is fragile and may become ineffective if it isn’t stored exactly right. The WHO factsheet on measles says that 15% of children don’t develop immunity after the first vaccination, so they recommend two vaccinations (and perhaps they have to be at a certain interval). See http://www.who.int/mediacentre/factsheets/fs286/en/
So your experience doesn’t necessarily imply that your immune system reacts unusually to measles. That you would say this about measles in particular, when there are all these problems with the measles vaccine, makes me wonder if you just haven’t been vaccinated effectively.
The WHO also says flatly that people who recover from measles are immune for life. So this is at least quite rare. Maybe you were misdiagnosed, maybe you actually had German measles or something else. From what the WHO says, it’s quite a heavy-duty disease to go through.

Oh really? We should stop vaccinating then since its worthless a.k.a. not 100% effective.

Except the odds of that happening are quite rare, and the second dose does help.

The Fab of an antibody is essentially random due to rearrangements and random mutations. This allows our immune system to recognize an infinite number of antigens.

If a B cell happens to make an antibody that recognizes a viral protein, that B cell will divide. If the the antibody doesn’t neutralize the virus (ex. block viral entry), that clonal expansion of B cells and long lived plasma cells won’t really help prevent infection.

Upon reinfection those memory cells will again expand and create even more non-neutralizing antibodies. The second exposure will also stimulate more primary B cells, so more exposures decrease the odds of a person not mounting a neutralizing response.

Everyone please, remember Rule 14 of the Internet and don’t feed the troll.

Regarding triskelethecat’s unique situation; when she was young her mother said she had measles…mostly like so…as measles was considered a childhood disease that most kids contracted before the age of 15 and before the single antigen vaccine became available. People born before 1957 are “considered immune” to measles. If you work in the health care field, testing for the presence of IGG antibodies against measles is always done…in the rare instance of an older person who somehow avoided the disease.

She also had a single antigen measles vaccine in the 1960s…which may not have been an effective vaccine, but had two combined antigen MMR vaccines in the 1970s and in the 1990s upon entry into grad school. Post immunization testing reveals a level of IGG that is not in the immune range. This is a rare response to the MMR immunizations. Studies have shown that immunizing with a third MMR may evoke an “anamnestic response” (exposure to an antigen boosts the IGG antibody)…but in most instances it is a temporary rise in the IGG antibody. Would such people be able to mount an immune response, if only temporary, when exposed to the actual measles virus…not the live attenuated virus contained in the vaccine? There are no studies that I know of and no research being planned to deliberately expose such people, because it is unethical…same as the Vaccinated-vs-Unvaccinated studies proposed the anti-vax crowd.

Laura, the measles portion of the MMR is not the same as the 1963 measles vaccine. Yes, it takes more than one to achieve greater than 98% efficacy. That only means that triskelethecat falls in that remaining 2%, and the even smaller than 1% who can never become immune to measles. It has to do with a subtle bit of genetic variation, nothing to do with the vaccine technology.

What are you trying to say, Th1Th2? Do you have any idea how complicated the human immune system is? I only know the basics, and I know that it involves assembling RNA strands and protein chains like LEGO bricks, which is not simple.

Also, at least FMJ’s given a source. So far, all you’ve told us is that “it’s obvious”. Th1Th2, where are you getting your information?

Now, Th1Th2 said in post number 27: “Just give the ol’ nurse lilady a pertussis vaccine and she’ll give it you intravenously.” In post number 58, she denies ever claiming modern human vaccines are given intravenously. Tell me Th1Th2, did you think we wouldn’t notice?

“But, jimbobboy, Severian never had a cat named Triskele.” Yeah, yeah — it’s in the apocrypha. I swear, wolfies are worse than trekkies.

But that’s not important now. What I’m interested in is how best to reach the general population with a persuasive defense of science-based medicine. We’ve already seen that the crude straight-to-the-amygdala approach, coupled with some savvy Google-smithing, has been remarkably effective in reducing vaccination rates. How can we respond to that with a candid account of the evidence that’s likely to get through to people? I don’t mean J.B. and the Things; I mean the intelligent, as-yet-uncommitted general public.

Of note, there is a workshop on “Promoting and Defending Science-Based Medicine” at this year’s TAM. I’ll be there. Orac and the gang at SBM need to be there handing out the halberds and morning stars of the truth, because this is a cause worth fighting for.

Now, Th1Th2 said in post number 27: “Just give the ol’ nurse lilady a pertussis vaccine and she’ll give it you intravenously.” In post number 58, she denies ever claiming modern human vaccines are given intravenously. Tell me Th1Th2, did you think we wouldn’t notice?

What part of the vaccine insert which states CAUTION: DO NOT ADMINISTER INTRAVENOUSLY, don’t you understand?

You want proof that parenteral vaccines CAN be given IV? Let nurse lilady show it to you.

I suspect that the internet with all its conspiracies…big pharma and big government manipulation…is custom made for selling snake oil and disinformation. Still others visit popular web sites to get “the latest”, “most scientific” information about health care, alternative treatments and supplements offered up by con artists.

A few days ago, a physician posted on RI about the parents of her young patients “hovering” over the kids and being so subject to scary stories that they hear. The New York Times Magazine featured an article about “helicopter parenting”…which unfortunately is the case with so many young parents. Helicoptering leads to overly doting parents who tend to anticipate every need that the child wants…no wonder there is a burgeoning group of children who are speech delayed. Jeez parents, how about letting the toddler babble…that is how they learn to enunciate real words.

Helicoptering also leads to concerns about their child’s health and this is the psychological advantage that the sharks on the internet use every day.

So we now have absolute charlatans on the internet hawking their wares and some very educated and credentialed physicians who now offer “integrated” health care to appeal to parents who believe that anecdotal information, mommy intuition and what they read on the internet should form the basis of health care for their child.

@jre: Caught! Yes, the original Triskele the Cat was named for the dog in the story. I keep his name out of how much I loved him.

@Laura; Actually, I also had German measles (rubella) which I did develop an adequate response to and chicken pox (immune there, too). My mother was (is) the daughter of a GP and used to make rounds with him. She saw plenty of measles. She was very well aware of the presentation. While she admits she didn’t know I had rubella until it was nearly gone, she can tell quite lovely stories about trying to keep me in bed when I had measles. I was quite sick and the household rules were if you had a fever you had to stay in bed. With my brother in the house, she was not able to watch me as much as she wanted, and would often find me in the bathtub (the cool enamel was nice to lie on). I do quite clearly remember the cold water enemas used to lower my fever.

So the WHO is wrong when(if) they claim that recovering from measles will provide the person with lifelong immunity. It may provide MOST people with lifelong immunity. I am not one of them.

It’s sometimes hard to combat information that is received *first*- (PI) but still, I would hope that we can reach reasonable parents by *explaining* the tactics and MO of anti-vaccinationists, producing historical numbers about illness, and showing the horrible “science” used by anti-vaxxers as justification before using fear-induction as a last resort. (BTW, I had measles: just prior to getting my shot, I contracted it – the entire episode remains a blur, although I remember a darkened room, endless coughing, a doctor visiting, and relatives being very nice to me. My much older cousin tells me I was sick “for weeks”- the adults “worried” about my vision especially.)

On a lighter note, anti-vax’s Big Kahuna, RFK jr, is hosting a *grande fete au plein air* to which *your truly* is invited. I am *so* tempted to congratulate Robert on helping to clean up the river and enabling the anti-vax trend as well.

Congratulations on your child, anastacia. I am headed to Lancaster County this weekend with my six month old for a family reunion, and I’m frightened, too.

You should have seen the look on my doc’s face when I asked him how soon she could get her MMR. He doesn’t hear that often in my over-educated liberal coastal city. When my baby was born I idiotically took her to a few “sling wearing” classes so I could learn to properly carry her when walking the dog. As soon as I learned they were a bunch of homeopathic anti-vax woonuts, I ran.

Some even attended a school recently shut down due to the Pertussis outbreak!

On a darker note: Seth Kalichman (2010; J. Aids & Behav.)shows the internet as an HIV/AIDs denialist tool spreading mis-information about transmission ( and other data) that is reflected in attitudes of young gay men. He shows that the “newbie”( to the internet) phenomenon is an important factor in the subjects’ acceptance of the mis-information.

My mother was (is) the daughter of a GP and used to make rounds with him. She saw plenty of measles. She was very well aware of the presentation.

Doctors make misdiagnoses too, quite often. Measles gets misdiagnosed as other illnesses, and other illnesses must get misdiagnosed as measles.
I am just saying that you have a “story”, a way that you’ve interpreted your experiences, and it may not be true, given all the known problems with measles vaccines, and that people apparently rarely can get measles again if they’ve had it before.
Your interpretation has you being vulnerable to this bad disease as an adult and not much you can do about it. So if it’s wrong, that would be a good thing to know; maybe something other than getting MMR repeats separated by many years, would give you immunity. Maybe, as someone else pointed out, you already have immunity, just that your antibodies aren’t picked up by the standard test. After all, you haven’t actually gotten measles more than once, so you aren’t known to be in that rare group of people.
I’ve had to change my “story”, the way I see things, in much more major ways than this. So I’m just saying, you can be mistaken in your interpretation of things.
If you are interpreting things wrong, I guess it’s not that big of a deal. You would only be unnecessarily creating fears for yourself. Lots and lots of people do that, it’s an epidemic and no little needle jab can stop it.

@triskelethecat
Your interpretation of things includes a rare event – that you had measles once but aren’t immune to getting it again. It’s rare enough that I’ve found authoritative websites saying flatly that it doesn’t happen.
That’s why I’m skeptical of your interpretation.
After all, misdiagnoses are common. So maybe you haven’t actually had measles.
Maybe assessing people’s immunity status by antibodies is not very reliable, and it would be common to get a wrong impression that you aren’t immune, from that.
Also the measles vaccine can be deactivated from improper storage, and perhaps this is fairly common.
It’s not quite Occam’s razor, but there’s another kind of razor, or surgical implement to be used on stories: if they are rare, they’re unlikely to be exactly true, because, rare things are not common.
Medical students are notorious for not knowing this. I guess it’s one of the things people don’t just intuitively know.
But it’s a good principle: if you have a rare interpretation, question it.

I just read Sid’s blog. What a bunch of useless pharma-shill gambits and accusations without citation. Does anyone know if Sid has some kind of useful education or is he just another lame conspiracy nut that has chosen vaccines because he found a niche for himself?

Sid also hates poor people, non-whites, non-americans, and afflicted with denialism of several medical concepts (fluoridation, vaccines, global warming, Obama’s religion, and a weak form of HIV/AIDS denialsm).

Pretty much a poster boy for crank magnetism. On the plus side, he does infrequently say something funny.

I had measles when I was about 13. Back then when it was endemic in the United States, every parent knew how to identify the rash…it is an allover maculopapular rash that appears several days after first symptoms of fever, coryza and cough. I recall it to be quite a miserable disease, made somewhat tolerable by having my two siblings come down measles within a few short days. We all survived it, but a cousin a few years earlier was hospitalized with measles encephalitis with some lasting sequalae.

When I worked in public health we had sporadic imported cases, where parents took infants abroad to visit family and exposed the infants to measles while in a foreign country. It is recommended for children who are at least 6 months of age but under one year old, to get the MMR vaccine, before traveling to any country with reported outbreaks or where measles remains endemic. Once the infant reaches one year of age, the infant will require the 2 dose series of MMR vaccine.

I’m certain, with these recent outbreaks in the United States, that private physicians and clinic and emergency room staff are very aware of the prodrome period and early symptoms and have consulted textbooks for pictures of the rash…docs and nurses want to make certain that infectious cases do not expose vulnerable infants and adults in a health care setting.

@ Jay K: I read Sid Offal’s awful blog…par for the course for cluelessness about vaccine-preventable diseases. I took particular note of his conclusions about the human vectors of the disease (poor, black, Mexican)…which just shows his xenophobic superiority complex and his dismissal of the outbreaks as “a few mild cases”.

Just an FYI for Orac: an unvaccinated young woman in Australia recently died from diphtheria – the first reported case in 30 years. Luckily, about 90% of Australians are vaccinated against diphtheria, so hopefully this was an isolated case.

@ V. infernalis: I read the article about the young woman’s death. It was reported that she was not vaccinated against the disease and had recently returned from a trip to an (unnamed) foreign country.

When youngsters don’t complete the primary DTaP series and adults don’t get booster shots, major outbreaks of diphtheria are the result. On the web:

The MMWR article is quite a complete epidemiological study of the 12,865 cases. 98 % of the cases were lab test confirmed and apparently adults who didn’t receive booster immunizations were in large part responsible for the inability of public health officials to adequately contain the multiple outbreaks. Serious bacterial illnesses such as diphtheria, pertussis and tetanus require 10 years booster shots and failure to maintain high herd immunity against diphtheria and pertussis cause outbreaks. For personal immunity against tetanus, people should make certain that they receive booster shots.

If left to public perceptions I wonder if there will be an oscillation between fear of vaccine-preventable diseases leading to high vaccination rates, and fear of vaccine side-effects leading to lower vaccination rates.

Whether we like it or not, with high vaccination rates we will eventually get to a point where the disease is so rare that for an individual the probability of an adverse reaction to a vaccine is more likely than contracting the disease if they don’t get the vaccine. Vaccination rates will fall and disease rates will rise until people again become more afraid of the disease than of the vaccine. And so the pendulum will continue to swing.

I tend to think that compulsory vaccination (unless there are good medical reasons not to) with generous and easily obtained compensation for anyone suspected of suffering adverse reactions to a vaccine is the best way of dealing with this. Many of these diseases could then be permanently eliminated.

I tend to think that compulsory vaccination (unless there are good medical reasons not to) with generous and easily obtained compensation for anyone suspected of suffering adverse reactions to a vaccine is the best way of dealing with this. Many of these diseases could then be permanently eliminated.

…which is exactly what we have now in the USA (with a vaccine injury compensation system along the lines of the workers compensation system), so I doubt I will hold my breath waiting for this particular wished-for millenium to come.

What we have now is more accurately described as “compulsory vaccination (unless the parents kind of don’t want to).” Philosophical and (often faked) religious exemptions are far too common and easily obtained (not in all states, but in enough) to credibly state that the current situation meaningfully resembles Krebiozen’s description.

There are too many “maybe”s in your hypothesis for it to seem likely. “Maybe” MI Dawn’s mother misdiagnosed her. And “maybe” antibody titers aren’t very reliable. That’s the “[citation needed]” moment. And “perhaps” it is common for the vaccine to be deactivated by improper storage. Do you have any data on how common this actually is? As MI Dawn pointed out, you don’t start by looking for zebras: but if you’ve established that there are no horses present, you don’t immediately assert that zebras are impossible and reexamine the area to find the horse you must have missed.

@jud By “compulsory vaccination” I mean compulsory and enforced, which is clearly not the case now, as vaccination rates have fallen and diseases such as measles are making a comeback.

This may seem harsh and I know there are serious civil liberty issues around this, but if there was a global campaign we could wipe out most of these diseases in a generation or two. Then it would no longer be an issue at all for our children’s children, except for diseases with an animal reservoir. In the long run far fewer people would suffer and die, from the diseases or from the vaccines (whatever your beliefs about adverse effects from vaccines).

The MMWR article is quite a complete epidemiological study of the 12,865 cases. 98 % of the cases were lab test confirmed and apparently adults who didn’t receive booster immunizations were in large part responsible for the inability of public health officials to adequately contain the multiple outbreaks.

Actually, I wouldn’t characterize what we have in the US as compulsory by any stretch, because it only requires vaccinations for school entry. Adults have no state-mandated requirements, and if you choose to homeschool, you do not need to get your children vaccinated at all. And although my state requires even private schools to comply with vaccination rules, not all states even do that — so you may be able to skirt vaccination by attending a non-vaxing school. Indeed, this has happened and the result is pockets of vaccine non-compliuance where herd immunity is not merely compromised but is entirely absent.

Most (70%) fatal cases of diphtheria were unvaccinated, and the proportion of fatal cases who were unvaccinated ranged from 52% to 100% in the different age groups. Among 5- to 14-year-old children who died from diphtheria, 24% had been fully immunized (according to the immunization schedule at the time). This high proportion, the highest among fatal cases, can be partly explained by the fact that in the second half of the 1980s, children were often vaccinated with Td, which contains less diphtheria toxoid than does DTP, or with half dose of DTP. There was a marked difference in vaccination status between fatal and non-fatal cases, particularly among the younger age groups. Among children 0â3 years old, in particular, fatal cases were three to four times more likely to have been unvaccinated than were non-fatal cases.

This may seem harsh and I know there are serious civil liberty issues around this, but if there was a global campaign we could wipe out most of these diseases in a generation or two.

– Yes, there are civil liberties issues, though there’s a good chance enforcement of such public health measures would be found to be within the government’s Constitutional powers.

That isn’t nearly the greatest practical issue though. Those are, as I see them, the following:

– It would be politically impossible to get Congress or state legislatures to agree to Draconian enforcement measures. I don’t see that as a bad thing, for two reasons. First, I value civil liberties quite highly, even when innocent lives may be lost. (I say “may be” not because I have any doubt that failure to vaccinate results in the loss of innocent life, but because of other problems I discuss below.) Second, advance knowledge of the political impossibility of this alternative prevents political leaders from broaching the subject. That’s good, because simply mentioning that such measures were being considered would be enough to validate every anti-vaxxer’s paranoia and push many fence-sitters to the “anti” side.

– There’s no doubt whatever about the compulsory nature of the current drug laws. How have those worked out? Draconian enforcement hasn’t come close to ending drug use; has created the incentives that fuel a huge black market, leading to such unintended but perhaps not unforeseeable consequences as multiple massacres, each involving hundreds of victims, in Mexico this year alone; has possibly ruined through incarceration the lives of as many or more than the underlying drug usage would have (25 years ago when I worked in the federal court system, 50% of the federal prison population consisted of nonviolent drug offenders); and has served to delegitimize for many the entire enterprise of government anti-drug enforcement. So in a quest to make the good into the perfect, you want to apply similar sorts of “enhanced” enforcement measures to vaccination, which is as it stands arguably the most successful public health intervention of the past century?

It’s really quite sad that you claim that Orac is “willfully ignorant” of the risks of vaccination when (a) he’s written about them many times, (b) all you can come up with is very indirect evidence related to a decades-old instance of contamination, and (c) your own cites indicate that SV40 infections are naturally occurring so said contamination wouldn’t be expected to have been a significant part of any harm said virus might do.

And you know what would be the best way of preventing harm from oncogenic viruses? Vaccines for them!

Pathetic, really. At least try to understand the abstracts before citing them.

Hey, Jeffry –
I’m sure I’m not the only one who would love to hear what Orac has ever said indicating to you that he is “willfully ignorant to the iatrogenic risks of vaccination.” It sounds like something you pulled out of your ass, but maybe I missed that particular post.

More to the point, now that we’ve established that a list of titles and links to abstracts on Medline is acceptable to you as evidence of the dangers of vaccination, would you agree that a similar list of papers on the morbidity and mortality associated with vaccine-preventable diseases would constitute evidence of the benefits of vaccination? ‘Cause I’ve got my finger hovering over the “search” button right now.

Actually, it is perfectly ethical to do a case-control study of the vaccinated vs. the unvaccinated where circumstances have already created populations in both categories. For example, due to the unique history of vaccination in Poland, where the monovalent measles and MMR vaccines were introduced at different times, it is possible to compare autism rates for unvaccinated, monovalent- and MMR-receiving children. It’s not only possible, it’s been done. Let’s have a look at the results.

Hmmm … I am sure Jeffry has not heard of this; else, being a fair-minded person he would surely have modified his position. Jeffry?

@jud
I take your point about the practical issues involved. I am uncomfortable with the idea myself, but if these diseases are ever going to be eradicated, I think compulsory vaccination is the only practical way currently available.

I don’t think the ‘War on Drugs’ is a good analogy for vaccination against diseases. No one gets addicted to avoiding vaccination, or makes a huge profit from not vaccinating. Draconian regulations compelling measles vaccination, for example, would only be required to establish herd immunity (not 100% vaccination) until the virus was eliminated globally.

Wild measles viruses are only made by human cells in infected human beings and if no humans had measles, there would be no measles viruses outside laboratories. That would be the end of measles and measles vaccination. You can’t say the same or anything similar about drugs of abuse.

How were smallpox and polio (in the developed world) eliminated? Was vaccination compulsory? I know smallpox vaccination was compulsory in the UK with a fine for non-compliance at one time.

@ Krebiozen: I remember lining up at a local fire station at age 4 to get my smallpox vaccination…I was not vaccinated and there was an “imported” case of smallpox. My older siblings were vaccinated against smallpox as a requirement for school entry.

When I first went to Europe I had to be re-vaccinated for smallpox, as I would have have been stopped at the border upon my return to the United States and placed in quarantine.

My daughter in 1971, at one year of age received her smallpox vaccine as it was still a requirement for school entry. In 1972 the recommendation to vaccinate young children against smallpox was rescinded…smallpox vaccines for travel outside of the USA remained in place until 1982 after the WHO declared smallpox eradicated.

Discussion of the civil liberties issues surrounding compulsory vaccination tends to evoke some disturbing echoes, at least in the U.S. In 1905, the Supreme Court upheld the constitutionality of compulsory vaccination for smallpox (Jacobson v. Massachusetts), and that decision was cited, infamously, by Mr. Justice Holmes in 1927 to support his decision upholding compulsory sterilization in Buck v. Bell:

We have seen more than once that the public welfare may call upon the best citizens for their lives. It would be strange if it could not call upon those who already sap the strength of the State for these lesser sacrifices, often not felt to be such by those concerned, in order to prevent our being swamped with incompetence. It is better for all the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. The principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes. Jacobson. v. Massachusetts, 197 U. S. 11. Three generations of imbeciles are enough.

Today, that decision is widely regarded as a grotesque violation of basic human rights. It is also flogged by vaccine opponents as evidence that supporters of immunization are morally in the same camp as eugenicists. Certainly, any weighing of the benefits and risks of vaccination supports an argument for protecting public health through moral suasion, but an attempt to achieve the same result by coercion is likely to bring back memories of Buck, and may end up being self-defeating.

No one gets addicted to avoiding vaccination, or makes a huge profit from not vaccinating.

Addiction, I grant you. But what about parents whose fears about vaccinating their children would only be given credibility by the argument that “They don’t have the facts on their side, so strong-arming you and your little kids is their only alternative!”? Love of child is a force potentially as powerful as addiction, or perhaps even more so, yes?

A black market in forged proof-of-vaccination documentation is surely not a huge leap in such circumstances, so there’s one means of profit I can think of right off the bat.

How were smallpox and polio (in the developed world) eliminated? Was vaccination compulsory?

Here in the USA the law was not significantly different than it is now. What has changed is the large number of otherwise well-educated folks who think they are qualified to assess the medical risks, concomitant with a tremendous reduction in the apparent risk of non-vaccination, attributable, paradoxically, to the efficacy of vaccination.

I was born prior to the polio vaccine becoming widely available in the USA, and before smallpox was considered eradicated. You can bet my folks made sure I had the vaccinations for both at the earliest opportunity. I had nearly all of what were then known as “the childhood diseases,” since of course every kid got them. I made it through OK, but of course if there’d been the opportunity to skip the damn things my parents would have leapt at having me vaccinated for those, too. (The one I didn’t catch “in the wild” was rubella, luckily for my mom and younger siblings. I did get the vaccine for that when it became available, fortunately for my friends’ parents still of childbearing age.) And before I got the yearly flu vaccine as a matter of course, I got the flu quite a few times and was utterly, thoroughly miserable.

Of course all of these experiences now inform my eagerness to get the flu vaccine every year, and my insistence that my wife do so as well. (She was afraid of the idea of a needle the first time, then became terribly embarrassed at making any fuss when the actual experience turned out to be a complete non-event.) I’ve been lucky enough that even in the few years the vaccine isn’t a good match for the wild strain I haven’t caught it, so I’ve spent a long, wonderful period not experiencing what it’s like to be sick as a dog with the flu.

I’ve been lucky enough that even in the few years the vaccine isn’t a good match for the wild strain I haven’t caught it, so I’ve spent a long, wonderful period not experiencing what it’s like to be sick as a dog with the flu.

lilady: One barely-beneath-the-surface assumption of helicopter parenting is that a mother’s love for her child is supposed to be able to protect that child from any kind of harm, and that harm to a child indicates failed motherhood. So many anti-vax mommies truly believe that if their kid came down with a vaccine-preventable disease (VPD), their love would ensure that their kids were unharmed. Thus when you tell them that they need to vaccinate their kids, they interpret it as you telling them that they don’t love their kids enough to protect them from VPDs (if you ask them whether the mothers of kids who died from VPDs before vaccination loved their kids any less than today’s mothers do, they’ll rationalize it away).

Although this mortality report only covers the first half of the 20th century, it has a lot to tell us.
Have a look at the death rate from influenza and pneumonia. Notice a wee uptick in 1918? The flu epidemic killed far more people than the World War, and terrified Americans to the point that whole towns barricaded themselves and turned away strangers at gunpoint. It was the scariest event most countries had ever experienced, and yet the death rate at its peak was “only” 600 per 100,000 population. Yes, augustine — “most non flu vaccinating people” survived the epidemic of 1918. Most people in Europe survived the Black Death, too, but there is little enthusiasm today for bringing back bubonic plague. Well, maybe at AoA.

There is a lot more in that paper worth discussing — including the interesting fact that in 1900 around 2% of all Americans died before the age of 4, mostly from childhood diseases. Maybe, with the help of the Waldorf schools, we can revisit those sunny times.

@jre
A little OT but you reminded me of an interesting article I came across a while ago, here.

Back in the “good old days” of the American Civil War people developed the sort of chronic diseases in their 30s and 40s that we now associate with people much years older. It’s well worth a read for anyone interested in how health has changed over the past 150 years.

@ Krebiozen- Terrific article! I certainly know about the size differences as I like to look at women’s clothing in museums- although it sometimes makes me feel oddly like a giantess ( I’m 5’6″).

On the health issues: this contradicts the usual back story given by woo-meisters- supposedly, people *became* unhealthy *recently* because of toxins, pollution, pesticides, processed foods, pharmaceuticals, the medical establishment, vaccines, etc. They portray the 19th Century ( and previous eras) as a veritable Golden Age of purity, robust health, and longevity. Somehow they leave out TB ( didn’t they ever read a Victorian novel?), malaria ( outside the tropics), and the many diseases now preventable by vaccines. Apparently they never heard of the work of Florence Nightingale and Clara Barton. The CDC has an interesting entry on the elimination of malaria in the US during, and soon after, WWII: it was not achieved through homeopathy.

Augustine — the Aiello and Larson article is very good. You will note from the graphic in that piece that the crude death rate from infectious diseases has dropped steadily over the same period that vaccines were introduced. In fact, the death rate from any specific infectious disease has dropped as the vaccine for that disease has been introduced. The same data used to generate this graph show that vaccines have been astonishingly effective in reducing the rate of infectious disease. I’m sure you are not trying to say that if any disease has been reduced that the reduction must have been from one cause only, and thus that identification of a given cause would rule out all others. You could not possibly be that permanently wedded to an ideology, or, alternatively, that thick. Could you?

You will note from the graphic in that piece that the crude death rate from infectious diseases has dropped steadily over the same period that vaccines were introduced.

In case you’re selectively science blind, you’ll notice that the majority of deaths dropped BEFORE vaccines became vogue. The only thing you can say scientifically and logically about vaccines and saving lives is that they played a part in death in reduction. It appears to be a small part. We’ll never know because the variable was overlayed on the backdrop of changing socioeconomic factors, living conditions, and pathogen life cycles. You’ll never be able to tease those out with certainty and without error.

To make the claim that “vaccines saved us” from those deadly diseases in the past is disingenuous. But you probably think statins have saved us from heart attacks, also.

Augustine, if I were in a cranky mood, I might suggest that you are belligerent to no purpose, smugly ignorant, clumsily sarcastic, annoyingly needy in that no-social-life-but-can’t-play-WoW-cause-I’m-homeschooled way, and a walking sandwich board advertisement for Dunning and Kruger.

But — since I’m feeling generous, I will simply note that you are a time-waster, and killfile is my friend.

@ jre: I wasted my time on the graph and the article provided by Ugh Troll.

Ugh Troll, when talking about vaccines interjects a study about hygiene and sanitation practices…such as availability of clean water, indoor plumbing and the locating of outdoor toilets away from potable water supplies, mosquito/vector control measure, hand washing after toileting and before food preparation and how a well educated populace can prevent transmission of food and water borne diseases. The article has no mention of vaccine-preventable diseases, because it deals with sanitation and personal hygiene. It would be nice if troll knew the difference between santitation/personal hygiene and other preventive measures such as vaccines.

The subject of this particular blog is the how anti-vax people use the internet to spread their ideas…not sanitation and hygiene…duh.

Back now to the subject of this blog; there are a few of the Recommended Childhood Vaccines that provide immunity to infants and children against disease that are transmitted through the fecal-oral route. They are:

Polio (in the prodrome period it can also be transmitted through oral secretions)

Rotavirus

Hepatitis A (sometimes it is transmitted by men having unprotected sex with other men or through oral-genital contact)

Hepatitis B is considered a blood-borne disease and an STD transmitted by unprotected sex.

HPV (human papillomavirus) transmitted sexually

Tetanus vaccine is not transmitted with human to human contact…education and being fully vaccinated plus tetanus immune globulin are protective against the bacterium.

There are 10 additional Recommended Childhood Vaccines. They are Diphtheria Vaccine, Pertussis Vaccine, Measles Vaccine, Mumps Vaccine, Rubella Vaccine, Varicella Vaccine, Haemophilus Influenzae Type B Vaccine, Meningicoccal Vaccine, Pneumococcal Vaccine and the seasonal Influenza Vaccine. These 10 vaccines protect children from 10 potentially deadly viruses and bacterial illnesses and they are all transmitted through respiratory droplets. Improved hygiene and education about hygiene (cover your mouth when you cough or sneeze) and education about sanitation (disinfection of surfaces and fomites) have minimal effects on the transmission of these diseases.

People who are really educated in the basics of human physiology, chemistry, immunology, vaccine development, disease epidemiology, bacteriology and virology have an understanding about the impact all vaccines have on the decrease of disease incidence, prevalence and the decreasing rates or morbidity and mortality associated with vaccine-preventable diseases.

augustine, who recently entertained us by subtracting 40 from 2011 and obtaining 1963 as his answer, now regales us as follows:

[Not getting the flu] is typical of what most non flu vaccinating people experience.

Well, duh. Gee, so flu doesn’t have a typical incidence rate in the U.S. of over 50% of the population in a given year. Was anyone saying it did? Neither does cancer or heart disease. Are you opposed to reducing the incidence of those diseases (he asked, cringing at the potential stupidity of the answer)?

Yes, absolutely. Show em the black-and-white movies of wards filled with children with whooping cough. Show then the gravestones of kids that died with measles -related meningitis. Do it before they have to see their own kids names on similar headstones. Diseases are things that people *should* be afraid of.